Use Of Alternative Strategies Research Articles

Facing suspected child abuse – what keeps Swedish general practitioners from reporting to child protective services?

Objective. The aim of this study was to examine the reporting of suspected child abuse among Swedish general practitioners (GPs), and to investigate factors influencing them in their decision whether or not to report to child protective services (CPS). Design. A cross-sectional questionnaire study. Setting. Primary health care centres in western Sweden. Subjects. 177 GPs and GP trainees. Main outcome measures. Demographic and educational background, education on child abuse, attitudes to reporting and CPS, previous experience of reporting suspected child abuse, and need of support. Results. Despite mandatory reporting, 20% of all physicians had at some point suspected but not reported child abuse. Main reasons for non-reporting were uncertainty about the suspicion and use of alternative strategies; for instance, referral to other health care providers or follow-up of the family by the treating physician. Only 30% of all physicians trusted CPS's methods of investigating and acting in cases of suspected child abuse, and 44% of all physicians would have wanted access to expert consultation. There were no differences in the failure to report suspected child abuse that could be attributed to GP characteristics. However, GPs educated abroad reported less frequently to CPS than GPs educated in Sweden. Conclusions. This study showed that GPs see a need for support from experts and that the communication and cooperation between GPs and CPS needs to be improved. The low frequency of reporting indicates a need for continued education of GPs and for updated guidelines including practical advice on how to manage child abuse.

Towards to the improvement of the analytical response in voltammetric sensors based on rigid composites

In order to increase the efficiency of voltammetric transducers we have studied the use of alternative strategies to characterize and optimize the composition of composite electrodes based on graphite and epoxy. The electroanalytical properties such as limit of detection and sensitivity have been improved by optimizing the distribution of the graphite particles inside the composite materials. The composites were characterized and optimized by electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV) measurements. EIS measurements provide information about the electron-transfer rate, the double-layer capacitance, contact resistance and resistance of the solution. These optimized parameters are directly related with the response time, signal-to-noise ratio (limit of detection) and sensitivity, respectively. In addition, morphological and conductance characterization was performed by atomic force microscopy and complemented with scanning electron microscopy. The improvement of the electroanalytical response was evaluated by means of hydrodynamic amperometry measurements using different reference analytes.

Enhanced high-performance liquid chromatography method for the determination of retinoic acid in plasma. Development, optimization and validation

When determining endogenous compounds in biological samples, the lack of blank or analyte-free matrix samples involves the use of alternative strategies for calibration and quantitation. This article deals with the development, optimization and validation of a high performance liquid chromatography method for the determination of retinoic acid in plasma, obtaining at the same time information about its isomers, taking into account the basal concentration of these endobiotica. An experimental design was used for the optimization of three variables: mobile phase composition, flow rate and column temperature through a central composite design. Four responses were selected for optimization purposes (area under the peaks, quantity of peaks, analysis time and resolution between the first principal peak and the following one). The optimum conditions resulted in a mobile phase consisting of methanol 83.4% (v/v), acetonitrile 0.6% (v/v) and acid aqueous solution 16.0% (v/v); flow rate of 0.68mLmin−1 and an column temperature of 37.10°C. Detection was performed at 350nm by a diode array detector. The method was validated following a holistic approach that included not only the classical parameters related to method performance but also the robustness and the expected proportion of acceptable results lying inside predefined acceptability intervals, i.e., the uncertainty of measurements. The method validation results indicated a high selectivity and good precision characteristics that were studied at four concentration levels, with RSD less than 5.0% for retinoic acid (less than 7.5% for the LOQ concentration level), in intra and inter-assay precision studies. Linearity was proved for a range from 0.00489 to 15.109ngmL−1 of retinoic acid and the recovery, which was studied at four different fortification levels in phuman plasma samples, varied from 99.5% to 106.5% for retinoic acid. The applicability of the method was demonstrated by determining retinoic acid and obtaining information about its isomers in human and frog plasma samples from different origins.

Pazopanib Efficacy in Renal Cell Carcinoma: Evidence for Predictive Genetic Markers in Angiogenesis-Related and Exposure-Related Genes

Pazopanib, an oral angiogenesis inhibitor, is approved for the treatment of advanced renal cell carcinoma (RCC). Response to pazopanib monotherapy varies between patients, and no validated biomarkers predictive of treatment outcome have been identified. We tested the hypothesis that this variability is partially dependent on germline genetic variants that may affect pazopanib exposure or angiogenesis pathways. Twenty-seven functional polymorphisms within 13 genes were evaluated in 397 patients with RCC. Genetic association with progression-free survival (PFS) and objective response rate (RR) was analyzed using the Cox proportional hazards model and proportional odds model, respectively. Three polymorphisms in IL8 and HIF1A and five polymorphisms in HIF1A, NR1I2, and VEGFA showed nominally significant association (P ≤ .05) with PFS and RR, respectively. Compared with the wild-type AA genotype (median PFS, 48 weeks), the IL8 2767TT variant genotype showed inferior PFS (27 weeks, P = .009). The HIF1A 1790AG genotype was associated with inferior PFS and reduced RR, compared with the wild-type GG genotype (median PFS, 20 v 44 weeks; P = .03; RR, 30% v 43%, P = .02). Reductions in RR were detected for the NR1I2 -25385TT genotype, compared with the wild-type CC genotype (37% v 50%, P = .03), and for the VEGFA -1498CC genotype compared with the TT genotypes (33% v 51%). Germline variants in angiogenesis- and exposure-related genes may predict treatment response to pazopanib monotherapy in patients with RCC. If validated, these markers may explain why certain patients fail antiangiogenesis therapy and they may support the use of alternative strategies to circumvent this issue.

Food choice: student consumers' decision‐making process regarding food products with limited label information

AbstractFood label information theoretically facilitates consumer decision‐making and food choice, but the extent to which consumers actually use this information during decision‐making is a subject of considerable debate. Therefore, this study focused on the importance of label information in student consumers' decision‐making process when exposed to limited label information food in a cafeteria environment. Because of a paucity of research in this area, a qualitative research approach that was exploratory in nature was used, accompanied by semi‐structured interviewing and a vignette. Undergraduate students from the North‐West University, Potchefstroom Campus, in South Africa served as the target population. The findings suggest that internal and product‐related strategies are applied when food choices are made whereby the importance of label information only features in the latter strategy. Student consumers with a label interest were more inclined to use label information strategies in the absence of complete label information to base food choice on. Those with a lack of label interest made use of alternative strategies using product and personal‐related information, such as freshness and product knowledge to make decisions. The decision‐making process was more complex because of insufficient label information and product appearance, and thus previous experiences and habitual purchasing became more important to participants. Student consumers should be supported to make healthier food choices through food manufacturers supplying cafeteria products with more complete label information and by providing students with the knowledge to use label information correctly through educational programmes.

Issues with threshold masking in voxel-based morphometry of atrophied brains

There is great interest in using automatic computational neuroanatomy tools to study ageing and neurodegenerative disease. Voxel-based morphometry (VBM) is one of the most widely used of such techniques. VBM performs voxel-wise statistical analysis of smoothed spatially normalised segmented Magnetic Resonance Images. There are several reasons why the analysis should include only voxels within a certain mask. We show that one of the most commonly used strategies for defining this mask runs a major risk of excluding from the analysis precisely those voxels where the subjects' brains were most vulnerable to atrophy. We investigate the issues related to mask construction, and recommend the use of alternative strategies which greatly decrease this danger of false negatives.

Ethephon Elicits Protection Against Erysiphe necator in Grapevine

The grapevine (Vitis vinifera) is susceptible to many pathogens such as Botrytis cinerea, Plasmopara viticola, Erysiphe necator, and Eutypa lata. Phytochemicals are used extensively in vineyards to reduce pathogen infections, but the appearance of pesticide-resistant pathogen strains and the need for environmental protection require the use of alternative strategies. The phytohormone ethylene is assumed to play a role in the development of disease resistance. In the present study, we have treated grapevine foliar cuttings (Cabernet Sauvignon) with ethylene-releasing ethephon. This resulted in an increase in the number of pathogenesis-related protein (CHIT4c, PIN, PGIP, and GLU) gene copies and in an enhancement of phytoalexin biosynthesis by inducing the PAL and STS genes that correlated with the accumulation of stilbenes (antimicrobial compounds). Moreover, ethephon treatment triggered the protection of grapevine detached leaves and grapevine foliar cuttings against Erysiphe necator, the causal agent of powdery mildew (64% and 70%, respectively). These studies emphasize the major role of ethylene in grapevine defense.

Impaired, spared, and enhanced ACh efflux across the hippocampus and striatum in diencephalic amnesia is dependent on task demands

Diencephalic amnesia manifests itself through a host of neurological and memory impairments. A commonly employed animal model of diencephalic amnesia, pyrithiamine-induced thiamine deficiency (PTD), results in brain lesions and impairments similar in nature and distribution to those observed in humans with Wernicke–Korsakoff syndrome (WKS). In the current investigation, 2 separate experiments were conducted in which acetylcholine (ACh) efflux was assessed in the hippocampus and striatum of PTD-treated and pair-fed (PF) control male Sprague–Dawley rats. The goal was to determine under what behavioral conditions and in which brain structures ACh efflux was spared, impaired, or adaptively enhanced. In Experiment 1, rats were assessed on a spontaneous alternation task; in Experiment 2, rats were tested on a T-maze discrimination task that could be learned via a hippocampal- or striatal-based strategy. In Experiment 1, PTD-treated rats were impaired on the spontaneous alternation task and ACh efflux in the hippocampus during testing was significantly reduced, but spared in the striatum. In Experiment 2, PTD- and PF-treated rats did not differ in the number of trials to criterion, but PTD-treated rats demonstrated greater reliance upon egocentric cues to solve the task. Furthermore, ACh efflux in the striatum was greater during maze learning in the PTD-treated animals when compared to the PF animals. These results suggest that there is behavioral and systems level plasticity that can facilitate the use of alternative strategies to solve a task following diencephalic damage and WKS.

Mental imagery skills and topographical orientation in humans: A correlation study

Several studies provide evidence that mental imagery is critical for human navigation. However, the contribution of different mental imagery abilities to the individuals’ skill of using specific orientation strategies remains unclear. In the present study we assessed a variety of mental imagery skills and investigated their contribution in relationship with the selective individuals’ ability of forming and using a mental representation of the environment, namely a cognitive map. Indeed, despite the use of alternative strategies that individuals may adopt while moving along the same well-known route, cognitive maps are critical for orientation since they allow individuals to reach any target location from any place in the environment. We found that the ability to form a cognitive map was related to the specific ability of performing mental rotations of simple geometrical shapes, and the ability to imaging ourselves moving on a map. Other imagery skills such as the ability to generate mental images from memory or the ability of mentally manipulate objects were not correlated with the individuals’ performance in forming the cognitive map. Moreover, we revealed gender differences in forming a cognitive map, as well as in performing some of the mental imagery tests. We discuss these findings in order to shed more light on the specific role of mental imagery in human topographical orientation.

Differential cross-reactivity of monoclonal antibody OPD4 (anti-CD45RO) in macaques

Immunologic research in nonhuman primates is occasionally limited by the availability of reagents that cross-react in nonhuman primates. One major limitation has been the lack of a monoclonal antibody to CD45RO. Although the monoclonal antibody UCHL-1 is used to detect CD45RO isoforms in humans, it does not react with nonhuman primates, mandating the use of alternative strategies to define "memory" T cell responses in nonhuman primates. The current study examined the reactivity and specificity of another antibody against CD45RO, clone OPD4, in macaques. Here we demonstrate that OPD4 specifically labels memory CD4+ T cells in approximately 44% of rhesus macaques (Macaca mulatta) of Indian but not Chinese origin. In contrast, tissues from pigtail macaques (Macaca nemestrina) react with this clone, indicating that OPD4 may be useful for examining memory CD4+ T cells in certain macaques, but its utility may be limited in other species or even among individual macaques.

Current opinions on safer red cell transfusion practice and the appropriate use of alternative strategies

This report summarizes the need for changes in certain areas of transfusion practice that may have some beneficial effect in improving transfusion safety and reducing the ever increasing demand for the use of red blood cells. These dual objectives can be achieved through a continuous educational and quality awareness program, encouraging the use of other available alternatives, including implementation of transfusion triggers reducing hemoglobin values, increased application of peri-operative/post-operative blood salvage, introduction of improved additive solutions and apheresis double dose RBC with a standardized hemoglobin content per unit; and changes in the clinical/laboratory practices, in particular when preparing patients for surgery. It is only through continuous education integration of better diagnosis/development/research and clinical practices in targeted patients that one can anticipate making a true contribution to the plodding and controversial issue of predicting transfusion safety and the cost benefit value of alternative strategies for transfusion. The current opinions on “safer transfusion” through the use of currently available alternatives are highlighted with the goal of promoting the use of transfusion alternatives in everyday clinical practice.

Should cystectomy only be performed at high-volume hospitals by high-volume surgeons?

Monitoring and improving the quality of healthcare is an evolving process that involves patients, physicians, and healthcare purchasers. Growing interest is seen in addressing quality concerns with policy changes. Surgeon and hospital volumes for specific high-risk procedures have been shown to be predictive of posttreatment outcome, but debate continues as to if the evidence justifies changes in practices. We reviewed the literature for robust evidence that surgeon and hospital volumes are markers of improved outcome of radical cystectomy. Outcome can be measured by postoperative mortality, as well as complication rate, recurrence rate, and several other factors. Evidence suggests that outcome is improved after cystectomy performed at high-volume centers and by high-volume surgeons. The limitations of volume-based referral policies are discussed, and the use of alternative strategies is reviewed. A significant regionalization of cystectomy has already been established. Owing to their limitations, however, volume-based referral systems have not been embraced by all parties. New strategies will continue to evolve, and validation of these strategies will be required before clinical implementation.

Altered functional neuroanatomy of response inhibition in adolescent males who were born very preterm

Event-related functional magnetic resonance imaging (fMRI) was used to investigate the hypothesis that males who were born very preterm may show differences in relative strength of blood oxygen level dependent (BOLD) signals in selective brain areas during performance of a simple response inhibition task compared with term-born controls. Participants were eight males (mean gestational age at birth 28wks, [SD 2]; mean age at testing 16y, [SD 1] and 14 controls matched for sex, age (mean age 17y, [SD 1]), and IQ. A 'go-no-go' task was used to assess response selection and motor response inhibition in response to a visual stimulus. When the 'no-go' condition was contrasted with an attentional control condition, preterm participants showed reduced BOLD signal response bilaterally in the cerebellum, right caudate nucleus, and thalamus, and prefrontal areas including left inferior prefrontal and left anterior cingulate gyri. They also showed increased response mainly in temporal regions. These results suggest that despite good task performance, individuals who were born very preterm exhibit different BOLD signal responses in selective brain areas compared with controls which may underline the use of alternative strategies when challenged with motor response inhibition processing.

Impact of Peripheral Nerve Injury on Sensorimotor Control

Deficits in sensorimotor control are experienced immediately after nerve injury due to changes in the periphery and central nervous system. Muscle denervation and sensory loss often disrupt prehensile coordination requiring the use of alternative strategies. To effectively foster coordination postinjury clinicians should address not only impairments and function but motor control issues through the prescription of specific sensory and motor experiences. Engagement in carefully planned, therapeutic activity can take advantage of the nervous systems' ability to regenerate and reorganize following nerve lesions. This article reviews motor control issues and neural reorganization concepts that may influence the recovery of skilled prehension following upper limb nerve injury. It also provides clinical guidelines for examining and enhancing coordination.

Biological Control of Fusarium Wilt of Tomato – A Review

Fusarium wilt of tomato (Lycopersicum esculentum) caused by Fusarium oxysporum f.sp. lycopersici leads to high losses of tomatoes in many countries. Increasing restraints on the use of pesticides encourages adoption of use of alternative strategies of controlling the disease. Alternative strategies include use of biocontrol agents. Bacterial biocontrol agents with promising biocontrol activities against F. 0xysporum f. sp. lycopersici include Pseudomonas flourescens, P. putida, P. chlororaphis, P. alcaligenes, Bacillus subtilis, Streptomyces pulcher, S. canascens, S. citreoflourescens, S. corchorusii and S. mutabilis. Fungal biocontrol agents that are efficacious against F. oxysporum f.sp. lycopersici include Penicillium oxalicum, P. purpurogenum, Trichoderma harzianum, T. piluliferum, Pythium oligandrum, non-pathogenic Fusarium oxysporum Fo47 and Trametes versicolor. Biological control agents including bacteria and fungi have shown some promise for the control of Fusarium wilt of tomato. This paper discusses the mode of action of non-pathogenic strains of F. oxysporum, other fungi and bacteria including fluorescent pseudomonads in the management of Fusarium wilt of tomato. The relative importance of systemic induced resistance in the suppression of Fusarium wilt is discussed. Key Words: biocontrol, induced resistance, rhizosphere, tomato wilt. J. Trop. Microbiol Vol.1 2002: 74-78

Crisis Intervention on Campus: Current and New Approaches

Critical incidents, whether a natural disaster, interpersonal violence, or death of a student, continue to be an unfortunate aspect of campus life. This article discusses the resulting use, potential overuse, and possible misuse of psychological debriefing. Analysis and interpretation of recent scientific data for interventions similar to commonly used methods of campus crisis intervention are provided. Recommendations are offered for potential use of alternative strategies for responding to critical incidents.

Crisis Intervention on Campus: Current and New Approaches

Critical incidents, whether a natural disaster, interpersonal violence, or death of a student, continue to be an unfortunate aspect of campus life. This article discusses the resulting use, potential overuse, and possible misuse of psychological debriefing. Analysis and interpretation of recent scientific data for interventions similar to commonly used methods of campus crisis intervention are provided. Recommendations are offered for potential use of alternative strategies for responding to critical incidents.

Representation and retrieval of arithmetical facts: developmental difficulties.

One form of developmental difficulty with arithmetic affects the storage or retrieval of arithmetical facts, such as tables, which are required to implement arithmetical computations (Temple, 1991, 1994). Such difficulties may arise because of impairment in a specialized system for the storage of arithmetical facts or as a result of causally linked impairment in another cognitive domain. This study explored issues concerning the representation and retrieval of arithmetical facts in children with number fact disorders (NF) and in normal children, in particular the status of hypothesized linked impairments: short-term memory (STM) spans, counting skills, speed of speech, and speed of number fact and lexical retrieval. There was no evidence that NF children had weak STM spans on any span measure or that STM spans related to arithmetical fact skills. There was also no evidence that NF children had weak counting abilities or free counting speeds. The NF children were slower in speeded counting, which also correlated with number fact skill. The significance or not of this is discussed. The NF children were also slower than controls in speed of speech and on some measures of speed of access. However, the absence of correlation with number fact skill, the absence of generality across tasks, and the possibility that delayed speeds in fact retrieval reflect the use of alternative strategies, together suggest that the increased speeds are not causally linked to number fact skill. The results are consistent with modular accounts, in which there is a specialized system for the storage and retrieval of arithmetical facts.

HIV/STD Risk and Sexual Strategies Among Women Family Planning Clients in New York: Project FIO

This report describes among 360 family planning clients in an HIV epicenter, women's HIV/STD risk characteristics, the barriers and facilitators of condom use within the context of relationships, and the use of alternative strategies for protection. Women attending the clinic were recruited for an HIV/STD preventive intervention and interviewed at baseline. At least 1 risk factor was reported by 77%, including a diagnosis of an STD within the last year for 30%. Recent STD diagnosis was associated with having a risky partner, but not with number of current partners. Women reporting consistent condom use had higher quality of couple communication, stronger intentions to prevent pregnancy, more positive reactions to condoms themselves and from their partners. Alternative risk reduction strategies, including using a barrier method other than condoms, refusing sex, engaging in nonpenetrative sex, leaving a relationship due to STD concerns, or undergoing mutual HIV testing had been used by 39% of women in the past 3 months.

A study of the use of seclusion in an acute psychiatric service.

In recent years, increased attention has been paid to significantly restrictive practices taking place in psychiatric services in New Zealand. The aim of this study was to prospectively examine the frequency of use of seclusion and the factors associated with its use in the acute general adult psychiatric wards serving the Waikato area. Information on the use of seclusion and relevant demographic data were collected over a 9-month period in 2000. The patterns of locked seclusion use and the characteristics of patients who had been secluded were examined. Analysis compared patients requiring one or more episode of seclusion (n = 84) with those never secluded (n = 455). Of a total of 539 patients admitted to the general adult unit during our study period, 84 (16%) were secluded in 129 seclusion episodes. About two-thirds of the seclusion events were initiated in the first week of the patient's admission, and three-quarters of secluded patients had only one episode. The median duration of seclusion was 14 hours. Comparison of gender and race revealed significant differences between the groups. Diagnosis, but not age, had a significant effect on whether a patient would be secluded. Seclusion was mainly associated with risk of, or actual, violence toward staff, patients or property. This study shows that seclusion is regularly practiced in the psychiatric wards of the Waikato area. In the majority of cases, its use was related to actual or threatened violence. Male, non-European patients and patients with certain diagnoses were at particular risk for seclusion. More research is required to examine the most effective use of seclusion and also the development and use of alternative strategies in controlling aggressive behaviour.